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1.
Orphanet J Rare Dis ; 19(1): 227, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849913

ABSTRACT

BACKGROUND: Increased arterial tortuosity has been associated with various cardiovascular complications. However, the extent and role of arterial tortuosity in non-atherosclerotic vascular diseases remain to be fully elucidated. This study aimed to assess arterial tortuosity index (ATI) in patients with non-atherosclerotic vascular diseases and the associated factors. METHODS: This is a retrospective analysis of patients with non-atherosclerotic vascular diseases referred to the Malformation and Rare Vascular Disease Center at the University Hospital in Lausanne (Switzerland). Computed tomography angiography (CTA) images performed between October 2010 and April 2022 were retrieved and the aortic tortuosity index (ATI) was calculated. Patients were classified based on diagnosis into the following groups: arterial dissection & aneurysm, arteritis & autoimmune disease, hereditary connective tissue diseases, and fibromuscular dysplasia (FMD). Univariate and multivariate logistic regression analysis was used to determine potentially relevant predictors of aortic tortuosity. RESULTS: The mean age upon computed tomography angiography (CTA) was 46.8 (standard deviation [SD] 14.6) years and 59.1% of the patients were female. Mean ATI was higher in patients over 60 years old (1.27), in those with arterial aneurysms (mean: 1.11), and in those diagnosed with hypertension (mean: 1.13). When only patients over 60 years old were considered, those diagnosed with connective tissue diseases had the highest ATI. At multivariate regression analysis, increasing age (p < 0.05), presence of arterial aneurysms (p < 0.05), and hypertension (p < 0.05) were independently associated with ATI. CONCLUSIONS: The ATI may be a promising tool in diagnostic evaluation, cardiovascular risk stratification, medical or surgical management, and prognostic assessment in several non-atherosclerotic vascular conditions. Further studies with longitudinal design and larger cohorts are needed to validate the role of ATI in the full spectrum of vascular diseases.


Subject(s)
Aneurysm , Computed Tomography Angiography , Hypertension , Humans , Female , Male , Middle Aged , Retrospective Studies , Adult , Hypertension/complications , Aneurysm/pathology , Aneurysm/diagnostic imaging , Vascular Diseases/pathology , Vascular Diseases/diagnostic imaging , Aged , Arteries/pathology , Arteries/diagnostic imaging , Age Factors
2.
Rev Med Suisse ; 19(853): 2298-2303, 2023 Dec 06.
Article in French | MEDLINE | ID: mdl-38063448

ABSTRACT

The lymphatic vascular system is essential for maintaining a healthy balance between interstitial fluid production and transport. Dysregulation of this balance can lead to the formation of lymphedema, a pathology that is disabling and bothersome in the daily lives of the patients. Lymphofluoroscopy is an invaluable tool that provides static and dynamic images of the superficial lymphatic vessels, with diagnostic and therapeutic implications. This diagnostic tool is beginning to take its place in the field of lymphology, as it is minimally invasive and has virtually no side effects.


Le système lymphatique vasculaire est essentiel pour maintenir un bon équilibre entre la production et le transport du liquide interstitiel. Une dysrégulation de cette balance peut amener à la formation d'un lymphœdème, pathologie invalidante et gênante dans la vie quotidienne des patients. La lymphofluoroscopie est un instrument précieux qui permet, avec des images statiques et dynamiques, d'observer le système vasculaire lymphatique superficiel, avec des implications diagnostiques et thérapeutiques importantes. Cet instrument diagnostic commence à prendre sa place dans le domaine de la lymphologie, car il est peu invasif et quasiment sans effet secondaire.


Subject(s)
Lymphatic Vessels , Lymphedema , Humans , Lymphedema/diagnostic imaging , Lymphedema/etiology , Lymphatic Vessels/diagnostic imaging
3.
Rev Med Suisse ; 19(853): 2304-2309, 2023 Dec 06.
Article in French | MEDLINE | ID: mdl-38063449

ABSTRACT

Peripheral arterial disease of the lower limbs (PAD) is a widespread disease whose diagnosis and treatment are still inadequate, despite several available current national and international recommendations. Screening for PAD is recommended in patients presenting with lower limb symptoms (claudication) and in those at risk. For all patients with PAD, initial management measures include treatment of cardiovascular risk factors, lifestyle modification, exercise training and antithrombotic therapy, at least for any symptomatic PAD. Revascularization is discussed on a case-by-case basis, depending on the stage of the disease, in a multidisciplinary setting. A diagnostic algorithm for PAD is presented, together with the basic principles of comprehensive disease management.


La maladie artérielle périphérique des membres inférieurs (MAP) est une maladie très répandue dont le diagnostic et le traitement sont encore insuffisants malgré l'existence de plusieurs recommandations nationales et internationales. Le dépistage de la MAP est recommandé chez les patients présentant des symptômes au niveau des membres inférieurs (claudication) et chez les personnes à risque. La prise en charge initiale de la MAP comprend le traitement des facteurs de risque cardiovasculaire, la modification du mode de vie, l'entraînement à l'exercice physique et le traitement antithrombotique, si symptomatique. La revascularisation est discutée au cas par cas en fonction du stade de la maladie dans un cadre multidisciplinaire. Un algorithme diagnostique de la MAP ainsi que les bases de prise en charge globale de la maladie sont présentés.


Subject(s)
Peripheral Arterial Disease , Humans , Risk Factors , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/therapy , Intermittent Claudication/diagnosis , Lower Extremity , Exercise
4.
Rev Med Suisse ; 19(853): 2310-2315, 2023 Dec 06.
Article in French | MEDLINE | ID: mdl-38063450

ABSTRACT

Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients.


Le syndrome de congestion pelvienne est une maladie invalidante souvent sous-diagnostiquée et sous-traitée, définie par de douleurs pelviennes chroniques, en présence de varices pelviennes chez les femmes ou plus rarement les hommes. Le diagnostic différentiel des douleurs chroniques abdominales est vaste et mène souvent à des parcours diagnostiques longs et coûteux. Le traitement conservateur est souvent insuffisant et une embolisation des varices pelviennes est le traitement de choix pour améliorer la symptomatologie. Un algorithme de prise en charge multidisciplinaire est proposé afin de faciliter le parcours de soins de ces patients.


Subject(s)
Chronic Pain , Embolization, Therapeutic , Varicose Veins , Humans , Female , Pelvis , Treatment Outcome , Syndrome , Pelvic Pain/diagnosis , Pelvic Pain/etiology , Pelvic Pain/therapy , Varicose Veins/complications , Varicose Veins/diagnosis , Chronic Pain/therapy , Embolization, Therapeutic/methods
5.
Rev Med Suisse ; 18(807): 2327-2330, 2022 Dec 07.
Article in French | MEDLINE | ID: mdl-36477279

ABSTRACT

Regular physical exercise reduces the risk of developing cardiovascular diseases. Along with cardiovascular risk factors management, physical exercise is considered as one of the main treatment components in people with cardiovascular diseases. The therapeutic role of physical exercise in patients with peripheral artery disease has been highlighted for decades. However, the role of physical exercise in the management of patients with venous, lymphatic, or rare vascular diseases remains poorly investigated. This article discuss the potential benefits of physical exercise in the therapeutic care of patients with vascular diseases.


Il est bien connu que l'exercice physique régulier diminue le risque de contracter une maladie cardiovasculaire. Chez les personnes avec une maladie cardiovasculaire, l'exercice physique est considéré, avec le contrôle strict des facteurs de risque cardiovasculaire, comme un élément capital de la prise en charge. Depuis des décennies, on met en évidence le rôle de l'exercice physique dans l'amélioration de la mobilité et de la qualité de vie des patient-e-s avec une maladie artérielle périphérique. Cependant, le rôle de l'exercice physique dans la prise en charge des patient-e-s avec des maladies veineuses, lymphatiques ou des maladies vasculaires rares demeure peu investigué. Cet article met en évidence les potentiels bénéfices de l'exercice physique dans la prise en charge des patient-e-s avec des maladies vasculaires.


Subject(s)
Cardiovascular Diseases , Vascular Diseases , Humans , Cardiovascular Diseases/prevention & control , Exercise , Vascular Diseases/therapy , Physical Therapy Modalities
6.
Rev Med Suisse ; 17(762): 2117-2122, 2021 Dec 08.
Article in French | MEDLINE | ID: mdl-34878738

ABSTRACT

Identification of subjects at increased cardiovascular risk (CV) using traditional risk calculators is established. Nevertheless, up to 50% of CV events occur in people classified as intermediate risk. Non-invasive atherosclerosis (ATS) assessment with carotid/femoral US and coronary artery calcium score, offers the opportunity of a personalized prevention. ATS detection could be useful in improving CV risk stratification, in optimizing individual therapeutic management and in promoting a shared decision-making process. Is this the era of a paradigm shift in CV-risk prediction? The fascinating question is still open, but the increasing number of evidences shed new insights for our everyday clinical practice. Here we strive to provide an updated scenario on the use of ATS imaging in the CV risk evaluation and therapeutic decision.


L'identification des sujets avec un risque cardiovasculaire (CV) élevé en utilisant les calculateurs de risque traditionnels est établie, cependant près de 50 % des événements CV surviennent chez des personnes à risque intermédiaire. Le dépistage de l'athérosclérose (ATS) par ultrason des artères carotides et fémorales et par le score calcique coronarien offre la possibilité d'une prévention personnalisée. La détection de l'ATS subclinique permettrait d'améliorer la stratification du risque CV, optimiser la prise en charge individuelle et la décision partagée. Est-ce l'ère d'un changement de la prédiction du risque CV ? La question est encore ouverte mais il y a des nouveautés concernant notre pratique clinique. Nous proposons un panorama actualisé du dépistage de l'ATS, son impact sur la stratification du risque CV et la décision thérapeutique.


Subject(s)
Atherosclerosis , Cardiovascular Diseases , Hypercholesterolemia , Atherosclerosis/diagnosis , Atherosclerosis/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Femoral Artery , Humans , Risk Assessment , Risk Factors
7.
Rev Med Suisse ; 17(762): 2128-2131, 2021 Dec 08.
Article in French | MEDLINE | ID: mdl-34878740

ABSTRACT

Peripheral arterial disease (PAD) is a major health problem in Switzerland, as myocardial infarction or stroke, all three sharing common cardiovascular (CV) risk factors and similar pathophysiological mechanisms (atherosclerosis). Unfortunately, PAD is still often overlooked, despite being fraught with significant morbidity/mortality and increasing the patient's overall CV risk. It is therefore essential to improve secondary prevention in order to decrease this burden and the overall CV risk of the patient. We will review the treatment targets for CV risk factors as secondary prevention in patients with PAD and see how the use of a vascular passport may improve management.


La maladie artérielle périphérique (MAP) est une problématique de santé majeure en Suisse, au même titre que l'infarctus du myocarde ou l'AVC, tous les trois partageant des facteurs de risque cardiovasculaire (FRCV) communs et des mécanismes physiopathologiques similaires (athérosclérose). Malheureusement, l'importance de la MAP est encore souvent sous-estimée, alors qu'elle est grevée d'une morbidité et d'une mortalité importantes et augmente le risque cardiovasculaire (CV) global du patient. Il est capital d'améliorer la prévention secondaire afin de diminuer ce fardeau et le risque CV global du patient. Nous allons passer en revue les cibles de traitement des FRCV en prévention secondaire chez les patients avec MAP et voir comment l'utilisation d'un passeport vasculaire permet d'améliorer la prise en charge.


Subject(s)
Atherosclerosis , Myocardial Infarction , Peripheral Arterial Disease , Stroke , Atherosclerosis/prevention & control , Humans , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/prevention & control , Risk Factors , Secondary Prevention , Stroke/prevention & control
8.
J Cardiothorac Surg ; 12(1): 78, 2017 Sep 06.
Article in English | MEDLINE | ID: mdl-28874169

ABSTRACT

BACKGROUND: Transcatheter aortic valve implantation is indicated in high-risk patients with aortic stenosis. We compared the clinical outcome of 180 consecutive patients who underwent transapical (TA) and transfemoral (TF) procedures in a single centre. METHODS: Ninety consecutive TA (TA-group) and 90 consecutive TF (TF-group) were performed from 2009 to 2014. Clinical variables were prospectively collected and retrospectively analysed for hospital outcomes and to identify risk factors for hospital mortality, vascular complications and stroke. RESULTS: Mean age was 80 ± 8.5 and 83 ± 8.4 years, in the TA and TF-group, respectively. TA-group presented higher prevalence of comorbidities: more vascular disease (79% vs 22%, p < 0.001), chronic pulmonary disease (32% vs 10%, p < 0.001), previous vascular surgery (14% vs 4%, p = 0.039), coronary disease (60% vs 40%, p = 0.007), and previous cardiac surgery (28% vs 17%, p = 0.073). Logistic Euroscore was 36 ± 15% in the TA-group and 25 ± 14% in the TF-group (p < 0.001), but hospital mortality was similar (TA:9%, TF:10%, p = 0.799). Access-related vascular complications occurred more often in transfemoral patients (TA:3%, TF:11%, p = 0.081) while major bleeding (TA:3%, TF:4%, p = 1) and stroke (TA:2%, TF:3%, p = 1) were equally distributed. Postoperative renal failure and dialysis were associated with impaired neurological outcome (p = 0.035 and p = 0.020, respectively). Mild to severe paravalvular leak was more prevalent in transfemoral patients (TA:5%, TF:25%, p < 0.001). CONCLUSIONS: In our experience, the TA and TF-group presented different risk profiles but mortality rate and adverse neurological outcome had a similar incidence. The transfemoral approach carried more vascular complications and paravalvular leaks but last-generation devices will improve this outcome.


Subject(s)
Aortic Valve Stenosis/surgery , Cardiac Catheterization/methods , Catheterization, Peripheral/methods , Postoperative Complications/epidemiology , Risk Assessment/methods , Transcatheter Aortic Valve Replacement/methods , Aged, 80 and over , Factor Analysis, Statistical , Female , Hospital Mortality/trends , Humans , Incidence , Male , Retrospective Studies , Risk Factors , Severity of Illness Index , Survival Rate/trends , Treatment Outcome
9.
Forensic Sci Int ; 269: 113-118, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27888720

ABSTRACT

The aim of this study was to characterize the concentrations of total and specific IgE as well as mast cell-derived tryptase in postmortem serum from femoral blood and evaluate the usefulness of their determination for diagnostic purposes in cases of fatal asthma attacks. 36 autopsy cases were retrospectively selected including cases of witnessed death in asthmatic subjects, deaths in asthmatics and atopic subjects with causes of death unrelated to asthma or allergic anaphylaxis as well as deaths in non-atopic, non-allergic individuals with causes of death unrelated to asthma or allergic anaphylaxis. Initial results indicated increased postmortem serum total IgE in atopic and asthmatic individuals, irrespective of the cause of death. Conversely, increased mast cell tryptase levels were noted exclusively in fatal asthma attacks. This suggests that mast cell tryptase measurement in cases of death potentially caused by severe acute bronchial asthma may be useful for diagnostic purposes.


Subject(s)
Asthma/diagnosis , Immunoglobulin E/blood , Mast Cells/metabolism , Tryptases/metabolism , Adolescent , Adult , Aged , Asthma/blood , Asthma/mortality , Biomarkers/blood , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
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